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Neuromuscular conditions Cerebral Palsy

Neuromuscular conditions Cerebral Palsy. Dr. Mohammed M. Zamzam Associate Professor & Consultant Pediatric Orthopedic Surgeon. Definition. Non progressive , cerebral damage occurring before brain maturation (1-2 years) resulting in muscle weakness, spasticity and other symptoms.

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Neuromuscular conditions Cerebral Palsy

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  1. Neuromuscular conditionsCerebral Palsy Dr. Mohammed M. Zamzam Associate Professor & Consultant Pediatric Orthopedic Surgeon

  2. Definition Non progressive, cerebral damage occurring before brain maturation (1-2 years) resulting in muscle weakness, spasticity and other symptoms

  3. Incidence 0.5-2/1000 in premature deliveries

  4. Causes Prenatal : Maternal disease/ Toxemia Cerebral deformity/ Hemorrhage Inborn error of metabolism Perinatal : Labour/ Respiratory complications Perinatal infections

  5. Causes • Postnatal : Infection Violence Convulsion

  6. ClassificationTopographic Classification • Diplegia : (Arms & Legs much more in legs), most patients eventually walk • Tetraplegia : (Arms & Legs & Trunk) High mortality rate, most pts unable to walk. IQ is low

  7. ClassificationTopographic Classification • Hemiplegia : Upper & lower limbs on one side (upper more than lower limbs), with spasticity, patients eventually walks • Bilateral Hemiplegia • Paraplegia (Legs) • Monoplegia • Triplegia

  8. ClassificationPhysiological Classification Spastic : • Commonest 50-60% • Most important for the Orthopedic Surgeon • Increased muscle tone (Jack knife spasticity) • Slow restricted movements • Increased reflexes • Babinski +ve

  9. ClassificationPhysiological Classification Athetosis : • 20-25% • ? Kernicterus • Involuntary, uncontrolled slow movement • Normal reflexes • +/- Muscle rigidity or tremors • NOT FOR SURGERY

  10. ClassificationPhysiological Classification Ataxia : • 1-5% • Inability to control /coordinate movement when they start • Intention tremor • Nystagmus / unbalanced gait • NOT FOR SURGERY

  11. ClassificationPhysiological Classification Rigidity : • 5-7 % • Lead pipe rigidity Mixed type : A combination of spasticity and athetosis with whole body involvement

  12. Presentation 3 year- old boy Presented with Inability to stand or walk

  13. Deformities Upper limb : • Shoulder adduction/internal rotation • Elbow flexion • Forearm pronation • Wrist and fingers flexion

  14. Deformities Lower limb : • Hip adduction/flexion/internal rotation • Knee flexion • Feet equinus / varus or valgus • Gait scissoring Spine : kyphoscoliosis

  15. The two most important x-rays during follow up

  16. Management Aim of treatment : • AS INDEPENDENT AS POSSIBLE • Avoid pain (hip arthritis) • Maintain sitting posture • Maintain spinal stability • Social benefit

  17. Management Multidisciplinary : • Orthotics before and after surgery • Physiotherapy/Occupational therapy • Orthopedic Surgery • Neurosurgery/ Pediatric Neurology • Speech therapy

  18. Management • History • Exam • Investigation • Treatment The degree of retardation is of great importance in treatment planning

  19. Management Exercise : • Start early (1st month) when suspected • Qualified Physiotherapist/ PARENTS • Prevent contractures • Develop coordination • Mental exercise • Use Orthotics/POP/Casts if needed

  20. Management Surgery : • Best in Spastic Hemiplegics and severe deformities • Contraindicated in Athetoid & Ataxic

  21. Management Goal of Surgery : • Decrease spasm • Release of contractures • Correct deformities • Rebalance muscles • Stabilize flail joints

  22. Management Options of Surgery : • Neurectomy • Tenotomy • Tenoplasty • Muscle lengthening (Recession) • Tendon Transfer • Bony surgery Osteotomy/Fusion • Spinal surgery

  23. Management Intramuscular botulinum toxin: • Temporarily reduces dynamic spasticity • It is thought that its use promotes normal muscle growth and avoids the development of soft tissue contracture

  24. Thank You

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